Beyond The Laptop
By
Deborah Tankard, OTR
Children with disabilities and those involved with them - parents, teachers, administrators, technologists, therapists, agree that Assistive Technology (AT) can be the great equalizer in the school setting. It enables independence and achievement, promotes inclusion, social interaction, self confidence and provides tools for those who interact with children with disabilities. However, many would concur, finding an evaluator who is aware of the holistic picture, sensitive and professionally responsive to all team players, can be a challenge. It is the intent of this article to present a case study which exemplifies Helen Hayes Hospital's Center for Rehabilitation Technology approach as a model for using the assistive technology specialist's multifaceted skills to create a team responsive evaluation and recommendations. The key ingredients are communication, collaboration, disability expertise, experience, and knowledge regarding the ever changing assistive technology options.
Scotty J. is a 12 year old with a Learning Disability who attends 7th grade at a local public school. He was referred by his mother for a "laptop computer" evaluation for use in school and home. The assistive technologist immediately had the following questions. Was the school team involved? What was the goal Mrs. J. hoped to achieve through the use of the laptop computer? Was this compatible with Scotty and the school players' objectives? Had any other strategies been tried prior to seeking assistive technology? What were the hardware and personnel resources in Scotty's environment? Communication was the first ingredient needed.
The Screening, phone interview(s) and a request and review of the IEP and pertinent reports, helped clarify the members' perceived problem and goals of the entire team, options already tried, and existing resources in the child's environment. Mrs. J. learned about assistive technology from another parent of a child with Learning Disabilities who was using assistive technology. Mrs. J. had not discussed the issue with the school and therefore was guided by the assistive technologist to involve Scotty's primary team. Since the assistive technologist is often not intimately involved with the child in the academic setting, collaboration with the school players assures that the assistive technology evaluation and recommendations match the child's academic strengths, weaknesses, and goals. In addition, it prevents duplication of services, facilitates the use of existing equipment and personnel, and assures that the recommendations are appropriate for the child's environment. In Scotty's case, communication via phone contact with the identified key players, the school Occupational Therapist and the Resource Teacher, helped clearly define the problems. Scotty had dysgraphia, an inability to write properly, and writing for classroom tasks was extremely challenging. Other options had not been explored. However, improved writing was the primary goal in his 2X/week Occupational Therapy sessions. An Apple IIgs computer was available in the resource room but was not used.
Through critical listening and questioning of all the players, a major obstacle was apparent. Candidacy was questionable due to Scott's motivation to use assistive technology. Also, it was clear that the assistive technology goals among the team members were different due to their varying perceptions of the potentials of assistive technology. Scotty was resistant to any "device" for fear of "looking weird." What child would not avoid something that they perceive as alienating? Mrs. J. was interested in a laptop computer to help Scotty with writing activities. What parent would not want what they perceive as the best for their child? The Occupational Therapist and Resource Teacher felt it was critical that Scotty continue to attempt to write while in school. What professional would not question an intervention that they perceive as not academically beneficial? In this case it was critical to give credence and attempt to understand the personal perspectives of all participants and look to strategies to bridge the gap. The common denominator among all the players was a need for more information regarding the no-tech, low-tech and high-tech options to address the presenting problem. This was accomplished by involving all the team in the evaluation process
Following a classroom observation of Scotty attempting to write, it was apparent he was a good candidate for an alternate approach to writing. However, this was only considering the functional factors. Scotty's emotional resistance needed to be kept in the forefront of this process.
It was decided by the team to proceed with the Device Trials, the hands on opportunity with the equipment, to allow everyone the opportunity to make an informed decision. This phase requires a thorough understanding of the child's presenting problems and the characteristics of various assistive technology devices to determine which of the many options would be appropriate to try. At first glance, the solutions considered included: a tape recorder, a student note taker, a keyboard note writer, or a laptop. However, all these options raised additional questions. Was Scotty experiencing fine motor difficulties with other tasks? Potential for keyboarding skills would need to be determined as touch typing is a fine motor skill. If Scotty was not a candidate for touch typing and needed to visually monitor the keys, would moving his eyes from the keyboard to the monitor be too distracting? Was he more effective with one particular mode of learning i.e., visual versus auditory? The answers to these questions would provide guidance in the device trial decisions.
The Occupational Therapist and the Resource Teacher were instrumental in providing information to these questions. Scotty did have difficulties in other fine and gross motor tasks such as shoe tying, skipping, and ball activities. Reportedly, his ability to learn through just listening was impaired and Scotty relied heavily on visual input to understand information. His reading was a relative strength. Considering this information, the tape recorder was ruled out and keyboarding potential was more closely evaluated. The SIPT, a standardized fine motor evaluation, indicated severe deficits in fine motor coordination and difficulties moving without visually monitoring his fingers. Scotty had no experience with a QWERTY, standard keyboard and when presented with a laptop, he used his index fingers on both hands. A timed test of typing versus writing for both auditory and written information was compared. Scotty was slightly faster with writing for both tasks. Taken at face value, one might rule out typing, however the lack of previous typing experience needed to be considered. Also during writing, Scotty was noted to have extraneous tongue movement and clenching of his non-writing hand, which possibly suggested significant effort. This was not seen during typing.
A treatment plan was jointly decided. Scotty's initial reaction to assistive technology had changed and he was interested in practicing typing with his Occupational Therapist using the Apple IIgs in the resource room. Based on his fine motor difficulties, the team decided that he was not a candidate for touch typing and he should practice using those fingers which felt most comfortable to him. Reorganizing the keys to an alphabetic order was ruled out as it was felt this would limit his ability to use other keyboards and computers. Mrs. J. now felt comfortable with the strategies developed, realizing the laptop was not the best tool for Scotty. Following a 6 month trial with typing, Scotty would be reevaluated to determine his speed and accuracy compared to writing. If at that time typing proved to be the best method of accomplishing written work, the AlphaSmart Pro would be one possibility. This low cost, portable device allows 64 pages of notes to be typed and stored and then printed using the school Apple IIgs. This system would not require significant staff and student training. This would allow Scotty to independently take notes and tests, and produce written assignments, the same as other students. In the meantime, note taking was supplemented with a peer's notes and class handouts when possible. Also, a volunteer from the Telephone Pioneers was recruited to transcribe tape recorded information from a class which was primarily auditory based. A school portable tape recorder was used. After trial, the team could also decide to continue with this approach.
System changes are on the horizon, and the barriers to the integration of assistive technology in the classroom will, hopefully, diminish. Identifying qualified assistive technology service providers and developing trust in their professional judgment is a starting place. Knowing when and when not to recommend the "laptop" computer through a collaborative team approach is one of the tasks at hand. u